Home care Medicaid rates in South Dakota are among the highest in the country for the services the state publishes in comparable units. South Dakota Medicaid pays $10.81 per 15 minutes for companion care on S5135, or $43.24 an hour. That ranks 2nd of 20 states and is 66.6% above the $25.96 national median. Hourly respite on T1005 pays the same $43.24, 3rd of 38 states and 70.9% above its median.
What makes South Dakota unusual is the uniformity. Companion care and hourly respite carry an identical hourly rate, and both sit near the top of their national rankings. The state does not publish an hourly agency personal care rate that can be ranked against other states, so these two services are the clearest measure of how it pays home care agencies.
South Dakota's current home care rates took effect on 2026-07-01. The main home care programs are the South Dakota HOPE Waiver for elderly adults and adults with physical disabilities, run by DHS Long Term Services and Supports, and the Assistive Daily Living Services (ADLS) Waiver, alongside fee-for-service South Dakota Medicaid.
| Service | Code | South Dakota rate | Rank | vs national median |
|---|---|---|---|---|
| Companion care | S5135 | $43.24/hour | 2 of 20 | +66.6% |
| Respite (hourly) | T1005 | $43.24/hour | 3 of 38 | +70.9% |
| Respite (daily) | S5150 | $302.16/day | 14 of 34 | +24.8% |
Adult day care on S5100 pays $3.77 per 15 minutes, or $15.08 an hour. Most states pay adult day by the day, so this rate is not ranked.
Only Vermont pays more for companion care, at $51.92 an hour. South Dakota's $43.24 is ahead of Montana ($37.56). At the other end, Nebraska pays $11.33, Iowa $8.48 and Arkansas $6.72.
In most states companion care is the lowest-paid service in the home care line, often well below personal care. South Dakota treats it as a full-rate service. For an agency, that means companion hours are not a loss leader here; they pay the same as respite, and a caseload weighted toward supervision and companionship can be as viable as one built on hands-on care. It also means service definitions matter more than price: the agency should confirm that each visit's tasks match the companion service the waiver authorized, since the rate alone gives no reason to bill one code over another.
At $43.24 an hour, South Dakota is behind only Virginia ($74.04) and New York ($59.32) for hourly respite. The bottom of the range is Nebraska ($14.95), Idaho ($14.04) and Indiana ($14.00).
Daily respite on S5150 pays $302.16, 24.8% above the $242.21 median. It ranks 14th of 34, solidly above the middle but well short of the leaders: Minnesota pays $938.09 a day.
Choosing between hourly and daily respite
The two formats are not priced on the same curve. A long day billed hour by hour at $43.24 would exceed the $302.16 daily rate, so for shorter stretches of relief the hourly code pays better per hour of staff time. The daily code suits genuine full-day or overnight coverage, where a single flat payment replaces many hours of scheduling. An agency should let the family's actual need and the authorization decide the format, and staff accordingly.
South Dakota prices most in-home services in 15-minute units. Companion care, hourly respite and adult day are all published per quarter-hour, and the hourly figures here are four units.
Two codes carry monthly limits in our data: hourly respite on T1005 and personal care on S5125. For an agency, that means a family that uses heavy respite early in a month may run out of authorized units before it ends. Schedulers should track units used against the monthly cap for each client and flag when a family is approaching it, so care can be planned rather than cut off.
The median wage for home health and personal care aides in South Dakota was $18.15 an hour in May 2025, above the $17.21 US median. Registered nurses earned $37.53, well below the $46.90 national median.
On both companion care and hourly respite, the aide wage is 59.7% of the $43.24 rate, leaving a margin of $17.44 an hour after a loaded wage. That is a comfortable margin by national standards, and it leaves room for travel, scheduling and supervision.
The relatively low nurse wage also matters for agencies whose programs require nurse oversight of aide services: supervision costs less here than in most states.
South Dakota's margins look strong on paper, but the state's geography is where much of that margin goes. Clients spread across long distances mean more unpaid drive time per paid hour than in a dense metro.
Practical ways agencies protect the margin:
- Cluster clients by route. Assign aides to geographic territories so consecutive visits are close together.
- Favor longer visits. A two-hour visit carries the same travel cost as a 30-minute visit; longer authorizations dilute it.
- Use daily respite where it fits. One trip for a full day of care is far more efficient than several short trips.
- Budget mileage explicitly. Treat travel reimbursement to aides as a direct cost of each client, not as overhead.
The $17.44 hourly margin is real room, but it is room that a poorly routed schedule can consume.
Home care funding in South Dakota comes through fee-for-service South Dakota Medicaid and several 1915(c) waivers:
- HOPE Waiver, for elderly adults and adults with physical disabilities, run by DHS Long Term Services and Supports. Daily respite on S5150 sits here.
- Assistive Daily Living Services (ADLS) Waiver, which carries attendant care.
- CHOICES Waiver, the comprehensive developmental disabilities waiver.
- Family Support 360 Waiver, for in-home supports for people with developmental disabilities.
Each waiver authorizes its own services and units, so an agency serving several should keep client records tagged by waiver.
Prior authorization in South Dakota's home care codes is light. S5100, S5130, S5135, S5150 and T1005 each carry one prior authorization rule in our data. Personal care on S5125 carries no prior authorization rule but has a monthly limit, as does T1005.
South Dakota does not run home care through capitated managed-care plans. The arrangements named for the state are the South Dakota Medicaid Primary Care Program (primary care case management), Care Connect health home providers, BabyReady providers and a dental vendor, 4 in all, and none of them sets home care pay. Home care agencies bill the state schedule. The South Dakota managed care page has the details.
For an agency, that is simple: one payer, one schedule, and no plan contracts to negotiate.
The current rates reflect a run of inflationary increases:
- HB 1326 (2026 session) General Appropriations Act SFY2027 enacted a 1.4% discretionary provider inflation for Long Term Services and Supports, effective 2026-07-01, and the same 1.4% for Rehabilitation Services.
- Inflationary increases for Personal Care Agency Services, the HOPE Waiver and the ADLS Waiver were implemented effective 2024-07-01.
- An earlier inflationary increase for Personal Care Agency Services took effect 2023-07-01.
Increases of this size keep rates moving with costs rather than resetting them. South Dakota's high standing in this line comes from where its rates started, not from one large recent jump. Agencies should expect the next change, if any, to arrive with the SFY2028 appropriations on a July 1 date.
For the services it ranks, South Dakota is near the top: 2nd for companion care, 3rd for hourly respite and 14th for daily respite, all above the national median. Agencies weighing a multi-state footprint should compare it with neighbors:
- Nebraska home care rates are near the bottom for companion care and hourly respite.
- Iowa home care rates pay $8.48 an hour for companion care.
- Minnesota home care rates lead daily respite at $938.09.
For the national picture, see home care Medicaid rates by state.
Budgeting. Build the forecast by code and unit. Companion care and hourly respite share a rate, which makes hourly revenue easy to project, but daily respite and adult day follow different units and should be modeled on their own.
Wage setting. South Dakota's margin gives agencies room to pay above the state median aide wage and still cover overhead. That matters in a state where aide wages already sit above the national median and recruiting in rural counties is hard. Test any raise against the travel cost per client, not just the hourly margin.
Planning around July. Rate changes in South Dakota arrive with the appropriations act on July 1. Update billing systems before that date and recheck the margin once the new rates post.
Benchmarking. Because South Dakota pays near the top for the services it ranks, the national median is a floor for comparison, not a target. Neighboring states are the more useful benchmark for agencies recruiting from the same labor pool.
Each rate is compiled from official South Dakota Medicaid publications and links to its source document. South Dakota's full dataset holds all 41,546 current South Dakota Medicaid rates, with history back to 1988; the South Dakota Medicaid rates hub covers every service line. Hourly figures convert 15-minute units at four per hour, and rankings compare each state's rate for the same service. Our methodology explains the details.